Breast milk supply drop at six months

SIX MONTH DROP

For the first six months after birth, baby is supposed to be on an exclusive breast milk diet. At six months and beyond your breast milk goes through a major change. The volume of milk slowly drops because baby is eating and drinking other foods. They may also be sleeping longer at night and are more active during the day. Your milk is super smart and shifts with this drop to have more antibodies and a higher fat content. The breast makes milk based on how it is emptied and what your hormones are doing based on how old baby is. Your hormones are also shifting and you may start your monthly cycle again. Many experience a further dip in supply around the time with their period. If you’re exclusively breastfeeding, you may notice baby pulling or tugging on your nipple or using their hands to beat your chest while feeding. If you’re pumping, you may slowly start to see less milk each pump session. Usually months 5-7 are the hardest from a baby behavior perspective and it settles out again as baby eats more table food and your hormones adjust. If breastfeeding is your goal, just keep offering the breast and pumping often.

COVID-19 Vaccine and Breastfeeding

Absolutely everything you put on or in your body had a risk/benefit. Some things have more research and information and somethings are newer and were still discovering them. Nitrates, for instance, which are found in processed meats are known to cause colon cancer. Yet many people routinely consume them without a second thought. Starbucks had a sign at every store saying they know some of their products are known to cause cancer and to be aware of the risks. Fenugreek is not supposed to be taken during breastfeeding if you’re on thyroid medications, but many are unaware of the risk because they haven’t researched it and still drink teas and eat products containing it. We’re still researching and learning about marijuana and CBD in the breastfeeding population and haven’t figured out long term recommendations. Still, some chose to weigh the benefits to their unique story and still consume it while breastfeeding

Did you know the American Academy of Pediatrics and the Academy of Breastfeeding Medicine have completely opposite, yet compatible, protocols for safe sleep? AAP discourages bed-sharing while ABM supports it. My role is to educate you on both recommendations and help support whichever decision you make, while also taking your unique situation in mind. If you have a formula and breastfeeding preemie, I’m going to tell you to follow the AAP guidelines as the risk of SIDS is too great in your circumstance. If you have an exclusively breastfed, full term, healthy newborn, you can absolutely bed share when done safely and correctly and I will teach you how to do that.

My role as a lactation consultant is to educate you in what we do know and the most current information and support you in whatever decision you decide to make. The same goes for the COVID-19 vaccine. Yes, there is limited research and information, but from what experts do know, they are considering it safe while breastfeeding but to still make an informed choice for you and your family. Whether you chose to be vaccinated or not is a personal choice between you, your family and your health care team. As with anything you put in your body, it is a risk/benefit decision based on your medical and family history and risk of exposure. I completely understand if in your community you have limited risk and exposure to people potentially infected with COVID and you’re choosing to wait and see. I fully support your decision to seek more information and see evidence and research. I also fully support you if you chose to be vaccinated and continue breastfeeding. When we have more information I will continue to update what I present and how I educate.

Tandem breastfeeding

It’s common for a toddler, or an even older child, to ask to breastfeed after a new sibling is born. Toddlers who were weaned immediately before or during pregnancy may be especially curious. Many just want to know if you’ll say yes – or they may just want your attention or “babied” themselves. Continuing to breastfeed, or letting them try to breastfeed again after weaning, can ease the transition of gaining a sibling. They are less likely to be jealous of the baby who is always with mommy if they can nurse alongside them. Nursing your older child once the new baby arrives can reduce engorgement when colostrum transitions to mature milk and can protect milk production if your newborn is not feeding effectively. If you say yes to a weaned child, many will just touch, lick or kiss the nipple, some will have forgotten the mechanics of how to breastfeed and won’t have further interest. Others can successfully breastfeed again. If you are happy to nurse your toddler, go for it. If it is overwhelming, it is still your body and you get to decide when and for how long toddler is allowed to breastfeed. You may prefer nursing your baby and your toddler separately or together. Breastfeeding is normal and it is normal for children to be curious and want to breastfeed at 2, 3, or even 4 years old.

When you give birth your body will continue to produce colostrum, with milk becoming plentiful after around 3-5 days. As with your first baby, breastfeed at least 8-12 times per day to establish your milk supply. Some will feed their newborn baby first or encourage the older sibling to nurse less until breastfeeding has been well established to ensure the newborn has full access to breast milk. Look out for feeding cues and give your newborn unrestricted breast access to help ensure they get plenty of milk.

Some times if your toddler is breastfeeding frequently, they may lose interest in solid foods for a while from increased milk intake. They may have looser stools. This is normal and should regulate with time.

It can take a while before your body adapts to the needs of two different feeders. You may feel lopsided if one breast drains more than the other. Eventually things will even out and you’ll find your rhythm. Alternating breasts for each feed helps with development of newborn vision and keeps the size of your breasts balanced. However, some mums find that giving a toddler his ‘own side’ works for them.

You will not run out of milk, your body will make more to accommodate however many nurslings there are.

Taking longer to trigger a let down?

It is normal for let-down not to feel as strong as baby gets older. Some of us never feel let-down, and some stop feeling the let-down sensation as time goes by. This does not necessarily indicate that let-down is not taking place. Remember, just because you don’t feel it or it feels different over time, or any mean it’s not happening.

Signs of let-down include:

• Uterine cramping during letdown in the first week postpartum

• Baby’s sucking pattern changes from a quick suck-suck to a rhythmic suck-swallow pattern as milk begins to flow

• Feeling of calm, relaxation, sleepiness or drowsiness.

• Sudden thirst

• Leaking from the other breast

• Tingling, pins and needles sensation, itching, nausea, headaches, or negative emotions

Things that can be the cause of a slow or inhibited let-down:

• Anxiety, pain, embarrassment, stress, cold

• Excessive caffeine use, smoking, use of alcohol

• Certain medications

• History of breast surgery where nerve damage that can interfere with let-down.

• In extreme situations of stress or crisis, the release of extra adrenaline in can reduce or block the hormones which affect let-down from a fight or flight response

• Sometimes a cycle is created, where baby fusses and pulls off because the let-down is slow, which makes mom tense up, which makes the let-down even slower, etc.

• It’s normal to have a harder time letting down for the pump than baby.

Later into your breastfeeding journey, you may notice it takes longer to trigger a let-down. This is common and what works early on may change over time. ⁣

Check for possible causes:

• Worn pump parts that need replaced. Replace the valves and membranes often. Check for worn tubing.

• Make sure you’re pumping with the correct flange size. Nipples may become more elastic over time and a different size may be used. ⁣⁣

• Starting your period or are you possibly pregnant? Both can decrease milk production and impact let-downs.

• New hormonal birth control or medication? These may impact supply.

• Check your body. Tension, pain, cold, fatigued or anxiety may block the neurochemical pathways required for milk let-downs. ⁣⁣

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Tips to trigger let down:

• Try a different pump or flange size

• Use heat, breast massage/compressions, or vibrations to prompt milk flow

• Orgasm. The same hormone released during orgasm also causes let down. Studies show having an orgasm can help let down

• Relax. Use slow, deep breaths and meditation

• Singing or humming can also speed let-down

• Gently massage your breasts. Stroke your breast towards the nipple with the flat of your hand or edge of a finger. Gently roll your nipple between your fingers

• Watch videos of your baby. Smell their clothing. Remember the feeling of let down

• Use all of your senses to facilitate let-down. Concentrate on the sight, sound, smell and feel of your baby.

• Take a warm shower or bath prior to nursing

• If you are in any pain, consider taking a pain reliever about 30 minutes before you feeding. Pain can cause stress and inhibit let-down.

• Choose a calm, less distracting setting

• Turn on music or a tv show that you enjoy

• Skin to skin contact with your baby: Undress baby to their diaper and yourself from the waist up. Stay like this for 1-2 hours prior to a feeding

• Eat a favorite snack and drink a comforting beverage like warm tea

• Get comfortable. Sit in a comfy chair or lay in bed. You should be in a comfortable position

• Switch nurse: move baby back and forth frequently between breasts until let-down occurs

• Nurse in a warm bath

Reverse pressure softening helps let-down for some moms.

• Visualization. Take several deep breaths and close your eyes as you begin. Try to visualize and “feel” what the let-down response feels like for you (if you normally feel anything). Imagine milk flowing or use images of waterfalls. An excellent book on visualization techniques is Mind Over Labor by Carl Jones.

• Distraction: watch TV, read, talk to a friend, don’t watch the pump bottles.

One study has shown that the moms of hospitalized babies who listened to guided relaxation or soothing music while pumping had an increased pumping output. When mom listened to a recording that included both music and guided relaxation while pumping, in addition to looking at photos of her baby, pumping output was increased even more. In this study, the interventions led to moms producing 2-3 times their normal pumping output. Milk fat content also increased for these moms in the early days of the study. (Reference: Keith DR, Weaver BS, Vogel RL. The effect of music-based listening interventions on the volume, fat content, and caloric content of breast milk-produced by mothers of premature and critically ill infants. Adv Neonatal Care. 2012 Apr;12(2):112-9.)

Weight loss and breastfeeding

Breastfeeding fact: breastfeeding helps you burn calories because it takes calories to make calories. We need on average an extra 300-500 calories per day in our diet because our bodies need approximately 20 calories to make an ounce of breast milk. Not everyone will lose weight while breastfeeding. It depends on and how many calories they take in and how their body uses those calories related to their individual milk production. Food choices, hydration, activity levels, and genetics also all play a role on weight loss while breastfeeding

Weight loss and breastfeeding

Breastfeeding fact: breastfeeding helps you burn calories because it takes calories to make calories. We need on average an extra 300-500 calories per day in our diet because our bodies need approximately 20 calories to make an ounce of breast milk. Not everyone will lose weight while breastfeeding. It depends on and how many calories they take in and how their body uses those calories related to their individual milk production. Food choices, hydration, activity levels, and genetics also all play a role on weight loss while breastfeeding

Perspectives on breastfeeding

PERSPECTIVE

“My hospital nurse told me to feed baby every 2 hours with 15mL and my pediatrician told me to feed baby every 3 hours with 30mL.”

“My IBCLC told me there is a tongue tie but the ENT said there wasn’t one.”

“One consultant told me to use a nipple shield as lo as needed. The other said get off as quick as possible”

“They said don’t let baby feed more than 10 minutes per side, but my baby won’t stay latched that long.”

I hear this all the time in my practice and it can be confusing for families. Why did I get different advice from different people? Perspective. Doulas, midwives, pediatricians, even lactation consultants all come from their own training, education, clinical practice and personal experience. When in doubt, the best person to get lactation advice from is an IBCLC. They have had to go through extensive training and mentoring to become certified in the study of human lactation. But remember: even lactation consultants come from different perspectives.

A hospital based IBCLC typically only works with babies in the first 2-4 days after birth and may see dozens of babies in a week, getting only a short amount of time with each family. A private practice IBCLC may have more time to spend with you but experience and expertise may vary. An IBCLC who is also a nurse will approach breastfeeding differently than one who is also a feeding therapist or who started out as a mother who struggled to breastfeed and became passionate to help others going through what she went through. My best advice is find some one who listens to you, educates on why they want you to do something, and supports you in your journey. Because you have a unique perspective, too.

Lauren Archer, Love of a Little One doula, takes a picture of my midwife and newborn
This is the same image from Lauren’s perspective

Do I need to drink milk to make breast milk?

Humans by design are predisposed to be lactose intolerant. The only reasons Westerners (mostly) lost this intolerance was due to centuries of eating cheese and having their bodies evolve to adapt to consuming it. Lactose is the number one sugar in breast milk. It’s broken down by an enzyme called lactase which is supposed to disappear in early childhood, right around the time we would naturally wean. Asian cultures are predominantly lactose intolerant because their cultures have had cuisine sans cheese and cow’s milk for millennia (think traditional Japanese, Chinese, and Korean dishes. No cheese. No cow’s milk.) Yet in Western cultures it’s occasionally encouraged to drink milk to make milk. There is no scientific evidence to back this up. You do not need to drink cow’s milk or eat dairy in large quantities to make breast milk. You do need to stay hydrated, eat quality foods, and routinely empty the breast.

Whats that smell?

SWEATY AND STICKY

Do you feel hot, sticky, sweaty, sopping wet and a little stinky? Welcome to motherhood. It does get better. There is an actual biological point to leaking from every pore and that weird stench that accompanies it.

Not all of our senses are developed at birth. It would overwhelm our littles too much to go from a dark, wet environment to such a bright, crazy world to actually have every sense developed like ours. Their vision isn’t great and they have no depth perception. But they have a fully developed sense of smell. They have been getting to know your odors since their womb days. Your amniotic fluid was constantly changing in its scent based on what you ate and drank and your unique hormone combination. All that leaking you’re doing postpartum has a similar scent which serves to orient your baby back to you. Your body odors are familiar to your baby and it makes them feel safe and secure that they are with their birth person and not someone else. Your leaking smells also stimulate their hunger, which is why baby may constantly root when on your body even if they aren’t hungry. Did you know that the breast secretes an oil from those little bumps on your areolas that smells just like amniotic fluid? This helps baby locate dinner when they are ready to eat. Showering is normal, but avoiding the use of scented products can actually be very helpful and calming for your baby. While you may find your body odor unbecoming, know that to your baby it makes you feel like home.

Caffeine and Breast Milk

Caffeine is safe to take while breastfeeding in moderation (up to 300mg per day). Only about 1.5% actually enters breast milk. Caffeine enters your bloodstream about 15 minutes. It peaks in your blood within 60 minutes and has a half-life of 3-5 hours. The half-life is the time it takes for your body to eliminate half of the drug. The remaining caffeine can stay in your body for a long time. The half-life of caffeine is about 97.5 hours in a newborn, 14 hours in a 3-5 month old baby and 3-5 hours in a baby older than 6 months. Because caffeine takes much longer to clear out of a young baby’s system it is possible that high caffeine intake can make a baby irritable. If baby is sensitive to the caffeine now, they may not be when they’re older. Cut caffeine now and try again in a few months.

So if you drink a cup of coffee with 100mg of caffeine at 7am, you’ll have 50mg of caffeine in your bloodstream at 10am. Your baby would get 1.5mg of caffeine.

Every baby is different in how they react to caffeine. If you drank coffee while pregnant, your baby had an IV of caffeine (called the umbilical cord) and is already used to having it in their blood stream. If you didn’t drink coffee or switched to decaf, your baby may have a more noticeable reaction when you drink coffee. When drinking coffee after birth, go low and slow. There’s nothing you can do to decrease caffeine in your system except time. Start with a very small cup first thing in the morning and see how your baby reacts. Drinking your morning cup of coffee while your breastfeeding gives you the most time for the caffeine to peak and start decreasing before your next feeding.